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chances of sperm retrieval using mese or tese

just wondered if anyone can give me a little advice and my dh a bit of hope.....

dh was diagnosed with azoo and had all the usual tests carried out. his ultra sound scan came back with no obstructions visable and all his blood levels were in the normal range.

so now we have been advised for him to have a mese or tese to see if some sperm is present that we could use for icsi/ivf. we have our 1st apt with the urologist booked but my dh has just told me how worried he is there'll be nothing there. so what i would like to know is what are our chances of finding any sperm by a mese or tese when dh hormones etc are all normal. i was thinking we have a good chance as seen as though his hormones are indicating things are normal, but now i'm thinking is that naive and am i living in cuckoo land?? i would like to prepare myself if the chances are we won't find anything. will we possibly get an idea of our chances of extraction when we have our apt with the urologist?

what puzzles me and dh is that if there is some sperm in there then where's it going when it dies if sperm is made every 3 months...??? how can he have sperm in his testicles and it not be coming out....

is there anything dh can do to increase our chances of sperm been found. he is on 'pre pregnancy for fathers' pills as well as zinc and vit c. we also try to only drink in moderation. or is it a case of if there's something there its there and if there isn't there's nothing we can do?

sorry for the long post. any help would be appreciated. we are just a little worried now.

RE: chances of sperm retrieval using mese or tese

Hi BooBoo,

It is impossible to predict what will be found when sperm retrieval is attempted. If it is really the case that his hormone levels are normal then the diagnosis is, as you say, that of an obstructive azoospermia. This most frequently is due to bilateral tubal blockage, or being born without tubes. It is surprising therefore that the ultrasound did not show evidence of this, although this is not always reliable, and dye instillation is often done to confirm this, also as with female tubes.

MESA and TESA are surgical ways to access the epididimys and the testicle respectively and attempt to find some sperm, which can be retrieved and stored for use with ICSI. When there has been a long standing blockage the back pressure gradually turns off sperm production, as is the case with vasectomy. Any sperm in the system at that point degenerate and are absorbed into the body. Unfortunately this frequently results in the production of sperm antibodies which decrease the fertility of any ejaculated sperm if attempts are made to undo the blockage, or reverse the vasectomy.

The blockage and back pressure also damages sperm production in the testicles and proper sperm maturation and developement in the epididimys, so the quality of recovered sperm will always be poor. If he truly has an obstructive problem then there is a better chance the most of being able to recover some sperm, and it is important that this is done in a unit where such sperm can be frozen and stored. So make sure that this is the case. What you are doing now with zinc etc may help to improve the quality of any sperm, so carry on with this. There is not a great deal more that you can do, except wait and see what happens at surgery

when we see the urologist i will certainly address the issue of dye instillation if dh's results are indicating a blockage. this was also what confused me as i didn't understand how no sperm would be coming out if it wasn't for a blockage.

so i guess its just waiting to see then. surely this procedure wouldn't be carried out though if there wasn't at least a chance there would be something there. we are having the procedure carried out where any sperm recovered can be frozen as far as i'm aware so i'll make sure of that.

I think that Paul has answered all of your questions, but I just wanted to let you know that our con gave us a % based on DH's blood resulst and hormone levels of finding sperm. We were given a 65% chance of finding some, but as you know we were not successful, I am not telling you this to put you off or worry you but just wanted to make you aware that even if you had been given % then it is not guaranteed, and as Paul says there really is no way of knowing other than having the surgery done. To be honest, having a % for us gave us false hope, as you dont have any figures or guess-timates from your con, then you may have a very successful extraction, with sperm suitable for freezing for ICSI. I think what I an trying to say is that there are many factors and your con guessing the outcome based on DH bloods and hormones would not do you any favours, the best (and only way) is to have the extraction, to be sure.

It is a very anxious time for you both, but chatting things through (as you are doing) is great, the best way is to share your fears and thoughts with each other

I really hope it is good news for you both, have my fingers crossed for you xx